Some of the most devastating diseases on Earth — ALS, Parkinson’s and Alzheimer’s — may be connected to one of the world’s most ancient life forms: a ubiquitous photo-synthesizing bacteria that already wreaks havoc on the environment.
Most know it as pond scum.
Blue-green algal blooms damage pristine estuaries and the state’s natural freshwater treasures, such as Florida Bay, Indian River Lagoon, the Caloosahatchee River and Lake Okeechobee — the latter a backup water source for West Palm Beach. Known as cyanobacteria, this brand of pond scum can percolate in stagnant residential lakes in Palm Beach County.
In the past decade, a consortium of 50 scientists around the world led by firebrand ethnobotanist Paul Alan Cox found cyanobacteria produce a toxin called BMAA that acts like an arsonist in the human brain, leaving sticky plaque buildup around nerve cells and causing protein tangles within those neurons. It is the same calling card found in patients of these neurological illnesses.
Even more intriguing is a related discovery by Cox and his team that ingesting the organic compound L-serine reduces the effect of BMAA in Old World monkeys called vervets.
And all this research has strong ties to Palm Beach County, where philanthropists have bankrolled Cox’s research at the Institute for EthnoMedicine in Jackson Hole, Wyo.
Douglas and Liz Kinney of North Palm Beach learned of Cox’s research more than a decade ago and have helped raise $14 million for research through dinner parties across the country, with nearly half the money coming from local sources. The Kinneys are now looking to raise an additional $3 million to further finance Cox’s studies, including research involving 40 ALS patients to test the safety of L-serine.
“It’s a game-changer,” said Liz Kinney, describing how she witnessed L-serine countering a neurological illness in a friend who was paralyzed with Lewy body disease, which has signatures of both Parkinson’s and Alzheimer’s. “Within 10 days, he was speaking. He had much more life.”
Her husband, Douglas, an 84-year-old retired investment banker, acknowledged that linking these crippling diseases to environmental factors is risky because algal blooms of cyanobacteria take a toll on the lifeblood of Florida’s economy: tourism, fishing and agriculture.
As a result, most of the large nonprofits dedicated to these diseases are focused on research into a genetic trigger, he said.
“It’s going to cause controversy. It’s no longer the game of just killing plants or killing animals. It’s killing people — that is what this breakthrough says,” he said.
But Kinney is unconcerned with any political fallout. Cox’s research is too important. “Prevention is the Holy Grail in this business,” he said.
Among the research is a study looking at Florida waterways and lakes to see if there are ALS hot spots where algal blooms are routine. Releases from Lake Okeechobee feed such blooms, prompting protests on the Treasure Coast. It seeks to duplicate a study out of Dartmouth-Hitchcock Medical Center in New Hampshire that found clusters of ALS patients living near contaminated lakes in New England.
Evidence shows that BMAA can be ingested, even inhaled, by humans.
“The big question is whether exposure to these bacteria blooms can be a risk factor of Alzheimer’s and ALS. At this point, that is an open question,” said Cox before speaking at the Palm Beach Society of the Four Arts on March 17 as a way to say thank you to his supporters.
Like a novel
This scientific research tale plays out like a novel, starting on the island of Guam, a U.S. territory in the South Pacific.
Cox — already known for key findings to treat people with HIV and AIDS — discovered the same bacteria that is in pond scum had infiltrated the cycad tree, which the indigenous Chamorro people used to make flour. The Chamorros also ate a type of bat that feasted on the fruit of the tree. About a quarter of the Chamorro people were afflicted with some type of neurological disorder.
Cox discovered BMAA was the cause.
“It was like reading an Agatha Christie novel, trying to find out what was killing these people and searching for the smoking gun,” he said.
In his TED Talk on YouTube, Cox uses a slinky to represent the protein strand within a nerve, saying BMAA turns the strand into a twisted mess similar to how the once iconic toy often ends up. BMAA takes the place of a key amino acid in a brain’s nerve cells, causing it to tangle. The neurotoxin jams another signal used by the brain to pass impulses to the spine and the muscles.
Dr. Deborah Mash, director of the University of Miami’s Brain Endowment Bank, picked up Cox’s discovery and ran with it, finding evidence of BMAA in the brains of people from North America. Her team found BMAA in 23 of 24 samples derived from 12 Alzheimer’s patients, while a control group had very little of the neurotoxin. Samples from 13 ALS patients all tested positive.
What Mash didn’t find was even more important.
The brains of those who suffered from Huntington’s disease — a genetic neurological disorder — showed no signs of BMAA, providing further evidence that an environmental factor could be at play in ALS and Alzheimer’s.
In January, Cox, Mash and other researchers published a study by the prestigious Royal Society of London on the vervets. They found the monkeys developed neurological tangles and amyloid plaque deposits when fed fruit containing BMAA.
Even more astonishing, these neurological changes were reduced significantly when L-serine was added to the vervets’ diet.
Mash cautioned that the evidence our waterways choked with blue-green algae may play a role is intriguing, but warned: “Proximity is not causality. That is why the vervet study is so important.”
And other experts in the Alzheimer’s disease arena are not convinced that Cox’s research in Guam can be extrapolated and are awaiting studies on L-serine.
“While investigating rare forms of dementia can lead to insights into the more common causes of the condition, further research is needed to understand whether the findings have relevance to diseases like Alzheimer’s or motor neurone disease in other parts of the world,” Dr. Laura Phipps of Alzheimer’s Research UK told the BBC earlier this year.
On the ALS front, for at least 90 percent of those afflicted, there is no known genetic mutation. Researchers speculate there may be some interaction between genes and the environment.
The ALS Association did not respond to inquiries, but its website provides a clue as to why it hasn’t gotten fully behind BMAA research.
The association says aside from Guam, there has not been any confirmed ALS cluster: “There must be confidence that the cluster occurred due to a certain cause rather than chance alone, in order for clinics and public health agencies to spend resources.”
Larry Brand of the University of Miami Rosenstiel School of Marine and Atmospheric Science found high levels of the neurotoxin in sea life from Florida coastal water beset by algal blooms, including pink shrimp and blue crab.
He said Floridians should be concerned about algal blooms caused by water releases from Lake Okeechobee, long polluted by farmland and urban runoff stretching all the way to Orlando, and considered a source of algal blooms.
“I personally would never eat seafood from Indian River Lagoon or Florida Bay,” Brand said.
Brand also found BMAA in bottlenose dolphins in the Indian River Lagoon, which is plagued with large blooms of cyanobacteria. “They are seeing more and more dolphins seemingly exhibiting unusual behavior; they seem to be getting lost,” he said. “They had dolphins who were swimming up freshwater rivers, freshwater lakes and so on. It sounds just like an Alzheimer’s patient.”
Meanwhile, UM neurologist Dr. Walter Bradley is trying to replicate a study up north tying BMAA to ALS hot spots in Florida. He is halfway there.
“We find that the addresses of patients are not randomly distributed over the state,” Bradley said in a release on his findings in January.
“There are “hot spots” where more ALS patients occur than would be expected for the population of that area. We are studying … the local environmental factors that might be linked to those hot spots.”
Cox and his fellow researchers are clear that they are not saying definitively that BMAA usurps genetics in causing ALS or Alzheimer’s. Brand points out that some people may be more susceptible than others to BMAA, noting, for example, that not all life-long cigarette smokers develop lung cancer.
“No one is claiming BMAA is the only cause,” he said. “There has been all kinds of hypotheses in the past. Aluminum, brain trauma. There are probably lots of different things that lead to these neurological diseases. BMAA looks like it can be one.”
Solving vexing disease
Scientists are focusing on the mysteries behind three deadly neurological diseases.
Amyotrophic lateral sclerosis, or Lou Gehrig’s disease: Two to three of every 100,000 people are diagnosed annually.
Alzheimer’s disease: Accounts for up to 70 percent of dementia worldwide, affecting 48 million people. The cost of caring for Alzheimer’s patients in the U.S. is estimated to be $226 billion in 2015.
Parkinson’s disease: Resulted in 103,000 deaths globally in 2013 — up from 44,000 in 1990.
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